At our chiropractic office in Natrona Heights, PA we often utilize ice or heat as part of our treatment. We are often asked when to use ice for neck or back pain and when to use heat for neck or back pain.

Treating Pain with Heat


As a general rule of thumb, use ice for acute injuries or pain, along with inflammation and swelling. Use heat for muscle pain or stiffness.

How it works

Heat therapy works by improving circulation and blood flow to a particular area due to increased temperature. Increasing the temperature of the afflicted area even slightly can soothe discomfort and increase muscle flexibility. Heat therapy can relax and soothe muscles and heal damaged tissue.

When not to use

If the area in question is either bruised or swollen (or both), it may be better to use cold therapy. Heat therapy also shouldn’t be applied to an area with an open wound.

People with certain pre-existing conditions should not use heat therapy due to higher risk of burns or complications due to heat application. These conditions include:

  • Diabetes
  • Dermatitis
  • Vascular diseases
  • Deep vein thrombosis
  • Multiple sclerosis (MS)

If you have either heart disease or hypertension, ask your doctor before using heat therapy.

Applying heat therapy

Heat therapy is often most beneficial when used for a good amount of time, unlike cold therapy, which needs to be limited.

Minor stiffness or tension can often be relieved with only 15 to 20 minutes of heat therapy.

Moderate to severe pain can benefit from longer sessions of heat therapy like warm bath, lasting between 30 minutes and two hours.

Always apply heat wrapped in multiple layers or towels to avoid burning your skin.

Never lay on or sit on heat. Always apply on top; not under.

Potential risks of heat therapy

Heat therapy should utilize “warm” temperatures instead of “hot” ones. If you use heat that’s too hot, you can burn the skin. If you have an infection and use heat therapy, there is a chance that the heat therapy could increase the risk of the infection spreading. Heat applied directly to a local area, like with heating packs, should not be used for more than 20 minutes at a time. If you experience increased swelling, stop the treatment immediately.

If heat therapy hasn’t helped lessen any pain or discomfort after a week, or the pain increases within a few days, make an appointment to see your doctor.


Knowing when to use cold therapy and when to use heat therapy will significantly increase the effectiveness of the treatment. Some situations will require both. Arthritic patients, for example, may use heat for joint stiffness and cold for swelling and acute pain.

If either treatment makes the pain or discomfort worse, stop it immediately. If the treatment hasn’t helped much with regular use in a few days, you can make an appointment to see your doctor to discuss other treatment options. It’s also important to call your doctor if you develop any bruising or skin changes over the course of treatment.